Saturday 28 November 2009

Knee Surgery Part 2: Drugs, Muscle Wastage & Crutch Workout Videos

The Drugs and the Pain
As I mentioned in part 1, I was given morphine when I came round after the surgery. I was still wired via the top of my hand, so they whacked me with "2" (mg I assume) when I reported pain.

"Does it still hurt?"
"Yes"

Boom - another 2.

4 x 2 later, I said "Don't worry about it." I was starting to sound like a junky and it was clear that at this dosage, their willingness to administer the drug was going to run out well before it had a tangible effect. In any case, it was tolerable. It seemed only right I should be in at least some discomfort.

Shortly afterwards, they gave me two codeine and paracetamol tablets (30mg and 500mg respectively, combined). Later, after they had wheeled me to my room, they gave me another tablet, this time diclofenac, a non-steroidal anti-inflammatory.

Add to this two cups of strong coffee and the fading anaesthetic and you've quite a cocktail. I spent an hour sending ill-advised
Blackberry work emails from my hospital bed while I waited for Mrs M to arrive, then half an hour marvelling at the passing street lights.

The first two nights after the surgery were painful. As I mentioned in Part 1, the small scars left after keyhole surgery do not reflect the extent of the trauma underneath.

To fight this pain, I had been armed with a pack of the codeine/paracetamol 30/500's and a pack of diclofenac. Codeine every 4 hours, Diclofenac every 12.

The problem with codeine, as with all opiates, is that it causes constipation. Evidently I am especially sensitive because three days later I realised I was a stranger to the toilet seat; and the trouble with Diclofenac is that, as with all NSAIDs, it's not very good for your stomach.

I therefore went out of my way to medicate on the basis of need, rather than habit. As a result, I awoke squealing in pain once or twice, usually because I had slept with the leg in a bad position. I found the best approach was to avoid the meds during the day, then take them at night, thus ensuring a good night sleep in return for a little suffering while awake.
Muscle Atrophy and Physiotherapy
Never underestimate how quickly a muscle will waste away if you don't use it. Not going to the gym for 3 weeks will not appreciably reduce your leg muscle mass if you are reasonably active - simply walking up stairs is a strong enough signal to your body that you need those quads.

Yet when you put a leg into a brace [click to enlarge], your quad stops being used at all. Here, three weeks later, is the difference in size between mine. Note - this photo was taken in the mirror, so it looks as if the wasted leg is on the wrong side.


I'd been given exercises by the physiotherapist at the hospital. One was designed to progressively introduce bending to the knee, the other to tense the quads and prevent wastage. This latter was pretty lame, as the photo would suggest.

Had I realised the importance, I would have initiated my own program sooner; but it was not until 2 weeks later, when I saw my regular physio, that I realised how much muscle I had lost and that there was much more I could do to prevent it.

Now, I tense the muscle like a posing bodybuilder for 30-60 seconds a few times a day. In addition, I am doing Romanian (straight-legged) deadlift, which the physio also endorsed (I described the most recent session here.) It allows me to give the lower body a serious workout without affecting the knee.
Crutches
Although I can happily limp around my apartment with the knee brace on, it's not an efficient method of propulsion for longer journeys; and eventually it does start to aggravate the knee.

I took a fine pair of crutches home after the operation, and it has been interesting to experiment with ways to use them for exercise. Here are my top 3 crutch-based workouts.

Crutch Cardio
When using crutches to walk, you can rely completely on your upper body, or only a little. It depends how much you want to protect the affected leg from contact with the ground. Either way, it's actually rather an effective, low level workout because it combines upper and lower body effort. You can aslo move pretty fast once you get used to it.

Note: if, like me, you are crutching for up to an hour per day, it does take a few days to adjust. For the first week I struggled. Doing a few thousand shallow dips per day comes as something of a surprise to the triceps.

Crutch Leg raise
The video says it all - this was a good discovery and I expect to continue to use the crutches when I am working out at home and would like to do leg raises.


Crutch Balancing
As you can see, I need to work on this one... but it's pretty taxing and something to pass the time when you are waiting for trains or buses.


In three weeks the leg brace comes off. I can still only manage 70-80 degrees of flexion. Full fitness should come in two months. No doubt there will be a part 3 to this post.

Knee Surgery Part 1
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Friday 27 November 2009

Romanian Deadlift, BBS-Style

Location: Woodcock Sports Centre, Aston University & My Appartment
Date: 23rd & 27th November

* Monday *
Romanian Deadlift (with dumbbells) : 1 x 10 @ 22kg, 1x10 @ 32kg, 1x10 @ 36kg slow & strict
Total time: 3 minutes (included a warm up)
Post-Workout Nutrition: None - fasted until lunch.

* Friday *
Romanian Deadlift (with dumbbells) : BBS-Style - 140 seconds before failure @37.5kg per dumbbell.
Total time: 3 minutes (included a warm up)
Post Workout Nutrition: Hot lamb roasting juice from previous night 10 minutes later + cold pork and apple sauce from 2 nights before 60 miuntes later.

After succesfully testing Romanian (stiff-legged) deadlift last week, this week I threw in a couple of short sessions. It seems I can handle heavy weights without complaint from the knee and this is the perfect way to challenge the quads, which must stabilise the slightly bent legs through the movement.

Today's session, when I used the superslow BBS approach for a single set, was great. Towards the end I got that slightly sicky feeling normally reserved for Tabatas and of which I have recently felt starved. I was also able to maintain form and did not feel as though my lower back was unhappy with taking the movement to failure.
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Sunday 22 November 2009

Body by Science Session 21 + Knee Rehab Work

Location: Woodcock Sports Centre, Aston University
Date: 20th November

21st BBS Big 5 session:

Session 22*Session 21*Session 20Session 19Session 18Session 17Session 16Session 15Session 14Session 13Session 12Session 11Session 10Session 9

Session 8Session 7Session 6Session 5Session 4Session 3Session 2Session 1

LbsTULLbsTULLbsTULLbsTULLbsTULLbsTULLbsTULLbsTULLbsTULLbsTULLbsTULLbsTULLbsTULLbsTUL

LbsTULLbsTULLbsTULLbsTULLbsTULLbsTULLbsTULLbsTUL
Pull Down155
1551:401551:411551:421551:501551:431551:451551:48155-1551:551551:511551:491502:131501:51
Seated Row1201:441201:421152:021151:561151:311102:021002:15803:08
Overhead Press60
601:32601:32601:35601:39601:32601:43601:5060-601:36601:44601:48601:38601:36
Chest Press951:37951:52951:39902:01901:391001:111001:17901:28
Seated Row105
1051:331051:401051:461051:301051:261051:421051:48105-1051:481051:391051:381101:291201:04
Pull Down1451:561451:461402:091352:111302:151301:561252:151102:26
Chest Press85
851:20851:19851:21851:15851:24851:19851:2085-851:32 *851:1485(1:10)901:13951:03
Overhead Press601:33601:28601:37601:49601:37601:38601:4480, 700:35, 0:25
Leg Press340
----3402:153400:553401:33--3302:193301:42330-330-3301:333202:14320-
Leg Press3102:303002:012903:242802:12260-2503:02230, 2704.312002:57
Total Time
9 mins8 mins12 mins10 mins11 mins9 mins11 mins3 mins8 mins8 mins11 mins14 mins10 mins

25 mins14 mins25 mins25 mins22 mins28 mins27 mins
Rest period
8 days9 days11 days7 days9 days13 days14 days (8 for legs)20 days (for legs)7 days7 days7 days7 days8 days

9 days11 days6 days8 days7 days7 days8 days
Notes
Times amazingly similar to last session. Truly, this is maintenance. Leg still in brace so no leg press. Almost no change at all.Had knee surgery 6 days previously but having to keep one leg straight not really a problem for upper body exercises. Rope climbing may have affected pull downs, leg press improvement may be limked to back rest position. Still in calorie deficit. Low sleep & low calorie week & only seven days rest. Yet no other exercise between. Leg press first rep burned me out: maybe seat position wrong. Running at the weekend, swimming on Tuesday and bad sleep may have eroded benefits of longer, 9-day rest. Could have done more on legs but demoralisation set in. No leg due to recent fell face and another on saturday. snagnation across the board. Fatigue from race? Rest period too long? Calorie deficit? In spite of alcoholic weekend, some good progress. Could legs have benefited from the weekend laziness? Chest is blue because it's the best time on the correct machine. Leg press only this week due to recently skipping it - but no upper body because seeking longer rest period overall. Full session next week. No leg press because recovering from race. *Chest press not on ususal machine so may have affected time. Still feel like stagnation rules. No leg press because race on Sat. Stagnation on all exercises suggests 7 days rest no enough. Or not enough calories?Finally got that 4th rep with OH press. Because the chest press was in use, did leg press before chest and chest press on a different machine. Lack of progress in pressing is mitigated by pulldown and leg success. Overhead felt better even tho TUL staticLess rest and a change in exercise order threw timings into disarray. Surprised by Overhead Press not being better

Baffling underperformance on chest and surprising improvement on legs, which may partly reflect increased intensity.Finally finding the sweet spot for leg press. Much less rest, so not surprised by overhead press suffering. Previous week's overhead press gains may have been due to slower reps. First real signs of progress now that I have stability on the weights.No leg press, hence shorter workout time. Was saving myself for fell race at the weekend.Still finding it hard to judge the right weight for leg press.Struggled to find right weight for leg press. Still finding the correct weight for all exercises.Had to change weight with overhead because misjudged it.

"TUL" = Time Under Load
Red =
worse than last week
Blue =
best time ever on that weight
Black =
no TUL change /weight changed / improvement not exceeded a previous best

Additional Exercises
  • Romanian Deadlift (with dumbbells) : 2 x 10 @ 22kg per dumbbell, slow & strict
  • Hanging Leg Raise: 2 x 10
  • Standing under the smith machine loaded with 60kg and legs lightly bent for 2 minutes
Total Workout Time: 25 minutes

Post Workout Nutrition
: 6 x scrambled organic + chopped apple & cocoa powder, 45 mins later.

The TULs for this session are so close to the previous session, it's spooky. Bear in mind I cannot see the timer during the exercise, so this is not a case of me giving up because I know I've done enough. This is clearly maintenance in action. I have never recorded my progress (or lack of it) so meticulously, and would previously have dealt with stagnation by changing exercise, thus dodging the truth.

My weight and fat percentage have made good progress in the last 2 weeks and I am on target to shift out of caloric deficit into caloric parity or surplus after another couple of weeks, which I hope will break the stagnation. I will follow my hunger instead of fighting it.

Having taken advice from my physiotherapist on Thursday, I chose this time to throw in a few exercises to maintain quad strength while the knee recovers from the operation.

He told me I could do deadlifts with nearly straight legs and that raising my leg in a straightened form was also good. So I did some Romanian deadlifts with dumbells (didn't fancy dragging the bar past my keyhole scars!) and some hanging leg raises.

In addition, loading the quads with some weight by standing with them slightly bent is an acceptable way to stimulate them whilst still protecting the knee - so I got under the smith machine and loaded it up.

It was refreshing to go back to some of these exercises after a period of monastic adherence to Body by Science.

The knee coped pretty well and some mild swelling was easily quenched with the ice pack.
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Saturday 21 November 2009

Knee Surgery Part 1

I injured my knee the week I started this blog in February, mentioning it in my first post.

What I don't mention is exactly what caused it. It was this. Skip to the 4-minute point in the video. This is a fantastic exercise, but after about 15 reps done at full effort, my form starts to slip.

On this occasion, my left foot placement was not correct when I pivoted the dumbbells over my head to move into the squat thrust. My leg was fully flexed but not at a good angle, so when I quickly extended it to thrust, something popped out.

To get it back in, I had to fully extend my leg. Ouch. Once it was back in, it felt okay, so I did a Tabata on the rowing machine. I have no idea whether this did any more damage, but in retrospect it seems like a really stupid thing to do. At home I iced, elevated and compressed, and it seemed okay the next day - just a little tender.

10 days later it popped out again when I was stretching. At this point I was referring to the problem as "my medial collateral ligament popping over my knee cap", which I later found out not to be true.

Over the next few months, it happened a few times. I got quite good at popping it back in. Then I got quite good at avoiding it popping out in the first place. All I had to do was ensure good form and avoid excessive knee flexion. I was even doing pistols.

When I visited the physio, he manipulated my leg in various ways and announced himself to be unsure. When he inadvertently popped it out himself and heard the 'kerchunk' sound it made when it went back in, he immediately referred me for an MRI scan.

For the scan, they strapped me to a stretcher, stuck a pair of headphones on me with the radio channel of choice, cranked me into a huge, cylindrical device that looked like the Hadron Collider, then asked me to keep totally still while it made so much noise I couldn't hear the radio anyway.
This was not the machine I went into, but it looked the same: . Sadly this was not the nurse who looked after me either ;-)

Weeks later, the specialist scratched his chin before the startlingly detailed 3D representation of my knee this ordeal had yielded, then pronounced himself convinced. I had caused a small but significant tear in the shock absorber between by calf bone and the knee.

Bottom line: I could have a small operation now, or a large one in 30 years. The small one would be easy peasy - keyhole surgery, in and out in a day. Knee brace for a couple of weeks. If I were a footballer, I'd be back on the pitch in 6 weeks. So I booked the operation for the beginning of this month.

The surgery was a pretty slick affair. They knocked me out with propofol while asking me superfluous questions I now realise was to distract my attention while they administered the drug. I awoke 45 minutes later.

As I sat drowsily contemplating my strapped up, post-operative leg, the surgeon swung by to tell me the good news and the bad. Good news: he had found the interior of the knee to be healthier than expected - a good blood supply, apparently. He was therefore able to stitch up the tear rather than remove some tissue.

The bad news: this now meant I would need to wear the knee brace for 6 weeks... and if I were a footballer, it would be 3 months before I was back on the pitch. Since I was high on morphine and residual propafol when he delivered this news, I thanked him warmly and told him how pleased I was.

When I was alert enough to be driven home by Mrs M later, it was a struggle to get into the car. The brace holds the leg almost entirely rigid.
At home, I inspected the damage and took some photos. This is the brace on the knee: . Fashion was going to have to take second place for a while.
I would, of course need crutches to get around at any speed: .

Underneath the brace and the bandage, this was the scene. You can see the arrow drawn pre-operatively to ensure the surgeon got the correct knee: . It's difficult not to be amused by this apparently crude approach - but if it had been an amputation they were performing I think I would have welcomed every possible precaution, however basic.

Finally, the wounds underneath, complete with neatly tied sutures: .


I had gone into the operation without any real thought about the practicalities of recovery. This was partly because I had expected it to be relatively brief.

In fact there have been some significant challenges. The two small holes over my knee cap, which after 2 weeks are little more than small scars, belie considerable turmoil beneath.

In part 2:
  • Battling to prevent my left quad from wasting away
  • Reluctantly taking the meds and treating the swelling
  • Some good workouts using crutches
  • A video of the operation? I have been told that most operations like this are recorded and DVDs are often provided. I've emailed the specialist's secretary to ask for mine, and will of course share it with you if she obliges.
Knee Surgery Part 2: Drugs, Muscle Wastage & Crutch Workout Videos
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Saturday 14 November 2009

Body by Science Session 20 and Knee Surgery Photo

Location: Woodcock Sports Centre, Aston University
Date: 12th November

20th BBS Big 5 session:

Session 21*Session 20*Session 19Session 18Session 17Session 16Session 15Session 14Session 13Session 12Session 11Session 10Session 9

Session 8Session 7Session 6Session 5Session 4Session 3Session 2Session 1

LbsTULLbsTULLbsTULLbsTULLbsTULLbsTULLbsTULLbsTULLbsTULLbsTULLbsTULLbsTULLbsTUL

LbsTULLbsTULLbsTULLbsTULLbsTULLbsTULLbsTULLbsTUL
Pull Down155
1551:411551:421551:501551:431551:451551:48155-1551:551551:511551:491502:131501:51
Seated Row1201:441201:421152:021151:561151:311102:021002:15803:08
Overhead Press60
601:32601:35601:39601:32601:43601:5060-601:36601:44601:48601:38601:36
Chest Press951:37951:52951:39902:01901:391001:111001:17901:28
Seated Row105
1051:401051:461051:301051:261051:421051:48105-1051:481051:391051:381101:291201:04
Pull Down1451:561451:461402:091352:111302:151301:561252:151102:26
Chest Press85
851:19851:21851:15851:24851:19851:2085-851:32 *851:1485(1:10)901:13951:03
Overhead Press601:33601:28601:37601:49601:37601:38601:4480, 700:35, 0:25
Leg Press340
--3402:153400:553401:33--3302:193301:42330-330-3301:333202:14320-
Leg Press3102:303002:012903:242802:12260-2503:02230, 2704.312002:57
Total Time
8 mins12 mins10 mins11 mins9 mins11 mins3 mins8 mins8 mins11 mins14 mins10 mins

25 mins14 mins25 mins25 mins22 mins28 mins27 mins
Rest period
9 days11 days7 days9 days13 days14 days (8 for legs)20 days (for legs)7 days7 days7 days7 days8 days

9 days11 days6 days8 days7 days7 days8 days
Notes
Almost no change at all.Had knee surgery 6 days previously but having to keep one leg straight not really a problem for upper body exercises. Rope climbing may have affected pull downs, leg press improvement may be limked to back rest position. Still in calorie deficit. Low sleep & low calorie week & only seven days rest. Yet no other exercise between. Leg press first rep burned me out: maybe seat position wrong. Running at the weekend, swimming on Tuesday and bad sleep may have eroded benefits of longer, 9-day rest. Could have done more on legs but demoralisation set in. No leg due to recent fell face and another on saturday. snagnation across the board. Fatigue from race? Rest period too long? Calorie deficit? In spite of alcoholic weekend, some good progress. Could legs have benefited from the weekend laziness? Chest is blue because it's the best time on the correct machine. Leg press only this week due to recently skipping it - but no upper body because seeking longer rest period overall. Full session next week. No leg press because recovering from race. *Chest press not on ususal machine so may have affected time. Still feel like stagnation rules. No leg press because race on Sat. Stagnation on all exercises suggests 7 days rest no enough. Or not enough calories?Finally got that 4th rep with OH press. Because the chest press was in use, did leg press before chest and chest press on a different machine. Lack of progress in pressing is mitigated by pulldown and leg success. Overhead felt better even tho TUL staticLess rest and a change in exercise order threw timings into disarray. Surprised by Overhead Press not being better

Baffling underperformance on chest and surprising improvement on legs, which may partly reflect increased intensity.Finally finding the sweet spot for leg press. Much less rest, so not surprised by overhead press suffering. Previous week's overhead press gains may have been due to slower reps. First real signs of progress now that I have stability on the weights.No leg press, hence shorter workout time. Was saving myself for fell race at the weekend.Still finding it hard to judge the right weight for leg press.Struggled to find right weight for leg press. Still finding the correct weight for all exercises.Had to change weight with overhead because misjudged it.


"TUL" = Time Under Load
Red =
worse than last week
Blue =
best time ever on that weight
Black =
weight changed or improvement did not exceed a previous best

Post Workout Nutrition: Primal/Paleo Breakfast of Champion with chopped apple & cocoa powder (recipe here), 45 minutes later.

Lots of red, but we are talking a few seconds lower TUL on all exercises. A clear case of no progress forwards or backwards.

I am still alternate-day fasting and slowly stripping fat. I estimate I will be ready to move into calorie surplus around Christmas time. Which is probably fortunate.

I had knee surgery on Friday, so no legs press for 6 weeks; but I was happy performing the other exercises even with one leg straightened by a brace. I will do a post about the surgery experience. In the meantime, here's one photo of the aftermath...


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Sunday 8 November 2009

Body by Science Session 19: Back Rest Angle Affects Leg Press Significantly

Location: Woodcock Sports Centre, Aston University
Date: 3rd November

19th BBS Big 5 session:


Session 20*Session 19*Session 18Session 17Session 16Session 15Session 14Session 13Session 12Session 11Session 10Session 9

Session 8Session 7Session 6Session 5Session 4Session 3Session 2Session 1

LbsTULLbsTULLbsTULLbsTULLbsTULLbsTULLbsTULLbsTULLbsTULLbsTULLbsTULLbsTUL

LbsTULLbsTULLbsTULLbsTULLbsTULLbsTULLbsTULLbsTUL
Pull Down155
1551:421551:501551:431551:451551:48155-1551:551551:511551:491502:131501:51
Seated Row1201:441201:421152:021151:561151:311102:021002:15803:08
Overhead Press60
601:35601:39601:32601:43601:5060-601:36601:44601:48601:38601:36
Chest Press951:37951:52951:39902:01901:391001:111001:17901:28
Seated Row105
1051:461051:301051:261051:421051:48105-1051:481051:391051:381101:291201:04
Pull Down1451:561451:461402:091352:111302:151301:561252:151102:26
Chest Press85
851:21851:15851:24851:19851:2085-851:32 *851:1485(1:10)901:13951:03
Overhead Press601:33601:28601:37601:49601:37601:38601:4480, 700:35, 0:25
Leg Press340
3402:153400:553401:33--3302:193301:42330-330-3301:333202:14320-
Leg Press3102:303002:012903:242802:12260-2503:02230, 2704.312002:57
Total Time
12 mins10 mins11 mins9 mins11 mins3 mins8 mins8 mins11 mins14 mins10 mins

25 mins14 mins25 mins25 mins22 mins28 mins27 mins
Rest period
11 days7 days9 days13 days14 days (8 for legs)20 days (for legs)7 days7 days7 days7 days8 days

9 days11 days6 days8 days7 days7 days8 days
Notes
Rope climbing may have affected pull downs, leg press improvement may be limked to back rest position. Still in calorie deficit. Low sleep & low calorie week & only seven days rest. Yet no other exercise between. Leg press first rep burned me out: maybe seat position wrong. Running at the weekend, swimming on Tuesday and bad sleep may have eroded benefits of longer, 9-day rest. Could have done more on legs but demoralisation set in. No leg due to recent fell face and another on saturday. snagnation across the board. Fatigue from race? Rest period too long? Calorie deficit? In spite of alcoholic weekend, some good progress. Could legs have benefited from the weekend laziness? Chest is blue because it's the best time on the correct machine. Leg press only this week due to recently skipping it - but no upper body because seeking longer rest period overall. Full session next week. No leg press because recovering from race. *Chest press not on ususal machine so may have affected time. Still feel like stagnation rules. No leg press because race on Sat. Stagnation on all exercises suggests 7 days rest no enough. Or not enough calories?Finally got that 4th rep with OH press. Because the chest press was in use, did leg press before chest and chest press on a different machine. Lack of progress in pressing is mitigated by pulldown and leg success. Overhead felt better even tho TUL staticLess rest and a change in exercise order threw timings into disarray. Surprised by Overhead Press not being better

Baffling underperformance on chest and surprising improvement on legs, which may partly reflect increased intensity.Finally finding the sweet spot for leg press. Much less rest, so not surprised by overhead press suffering. Previous week's overhead press gains may have been due to slower reps. First real signs of progress now that I have stability on the weights.No leg press, hence shorter workout time. Was saving myself for fell race at the weekend.Still finding it hard to judge the right weight for leg press.Struggled to find right weight for leg press. Still finding the correct weight for all exercises.Had to change weight with overhead because misjudged it.


"TUL" = Time Under Load
Red =
worse than last week
Blue =
best time ever on that weight
Black =
weight changed or improvement did not exceed a previous best

Post Workout Nutrition: 6 scrambled organic, fre-range eggs + chopped apple & cinnamon, 45 minutes later.

I was still alternate-day fasting leading up to this session and still working towards the goal of 11% fat, so I remain in calorie deficit.

I was not surprised by the slightly poorer performance on Pull Downs because I got carried away with rope climbing when on holiday between sessions. These were the videos (here and here) of the rope climbing. Shoulder Press, as ever, frustrates.

Paradoxically, since it's still a pulling exercise, I felt quite strong on Seated Row, securing close to my best TUL for that weight. I also came close to my best time for Chest Press.

None of this is cause for celebration because I am supposed to be progressing: but my thinking is that I am treading water in readiness for the increase in calories when I hit 11% fat. If I start messing around with exercise order or movement speed or intensity level at this point then it will be harder to judge the affect of the increase in calories.

Leg Press, on the other hand, may be a cause for celebration. Last session my TUL was under a minute because (I felt) the back rest was too vertical, making it very hard to get the first rep out. This time, I deliberately moved it back to a more reclined position and for the same weight my TUL was over 2 minutes. This is the one setting I had not been recording and I suspect it makes a big difference. I have now noted its position and will use that from now on.

However, since I have just come out of knee surgery, which requires me to wear a splint for 6 weeks, it will be a while before I do leg press again. Needless to say, I will continue with the other exercises in the meantime.
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